Friday, May 29, 2009

John at Cosmic Variance just wrote a dangerous (in my opinion) entry on healthcare. It is true that healthcare is very expensive (particularly in the US) and that having for-profit insurance companies sounds like a big conflict of interest, however, this topic is nowhere close to being a simple one.

Insurance companies often deny a procedure or treatment based on many different, and some times stupid (see here), reasons. Most likely, the motive behind the rejection is to increase profits by cutting down on expensive procedures. One side of the issue that is NEVER discussed is why the procedures are so expensive in the first place. Note that this has nothing to do with the insurance companies, a non-insured person can go to the doctor and pay out of pocket just to find out that a (typical) 45-minute MRI scan costs around $800, and this is probably on top of the cost to just get to see the doctor. Wikipedia even quotes a much higher cost (~$4000). According to the typical cost of the equipment mentioned on wikipedia, at $800/patient the $3 million investment would be recovered in about 4000 patients. Certainly doctors scan way more than 4000 in the lifetime of the MRI machine. MRI centers can probably get their investment back in one year (at 45-min/scan, they can do 10 patients in an 8-hour long work day. If they open for 300 days that is 3000 patients/year). In this case, I don't see the insurance companies abusing the patient, it's more like the doctors performing the procedure are overcharging for it.

Some people argue that doctors have to charge that much given the fact that they come out of school with a significant amount of debt. While this might be true, I don't see why medical school has to be so expensive. It doesn't really require that much more time to become a medical doctor (even with a specialty) than to become a professor in science (5 years of PhD, 3-5 years of postdoc experience). So why is one much more expensive than the other one? and why do medical doctors expect to make so much money when they get out of school? Maybe if the cost to become a doctor is cut down it will be more affordable for a patient to get treated. However, it's possible that it is too late for the US to make changes in this area; the culture of medical school is probably too ingrained in the people when you have many students going (or at least trying to go) to medical school just to become rich afterwards.

Can we do something as scientists? Well, for one, we not only need to be working on getting new technologies, but also on making the currently available ones way cheaper. This last point might sound more like engineering, but I still feel scientists can do a lot more to help on it.

Everybody (yes, even terminal patients) should get whatever treatment/procedure could possibly mean recovery, even if only temporary. Reducing costs by cutting treatment to terminal patients and instead offering counseling, as John suggests, is the wrong way to go. It is no different than insurance companies denying care because they think it will not matter at the end. We need to find other places to cut costs while at the same time we increase treatment to current patients and extend it to new ones.

Wednesday, May 27, 2009

Obama seems to believe there is (some) wasteful spending going to defense-related programs. I am sure many people (mostly republicans) believe these expenses are necessary for the security of the nation. While I am not republican, nor I agree with many of their ideas, I do believe defense is a very important part of any country and as such a lot of money should be spent on it. However, it is all about timing: is right now the best moment to invest on that particular technology? The answer is probably no for many of the ongoing programs. This got me thinking if there is any wasteful (well, I am not sure I would actually call it wasteful, but I will use it nonetheless at this point) spending in science.

First of all, I should say that if money was unlimited all science should be funded (no, not all defense programs should be funded) as far as I am concerned. However, given the fact that the budget for research-oriented agencies is relatively small (compared to the number of scientists and the cost of their proposed projects) many projects will have to go unfunded, at least for a few years.

As far as science is concerned everything is important, and I am sure every scientist out there believes their project is the most critical (or at least very important) for the particular field. But when taxpayer money is involved, I believe there is an obligation for the PI to not only think their projects through, but also to be objective as to whether or not this particular moment in time is the right one for that project to be funded.

For example, should a project (costing millions of dollars) that attempts to obtain a new decimal place for the gravitational constant, or the speed of light be funded when we have, for example, very serious diseases affecting us? Nevermind the possible energy and/or water crisis we might face in the future. (Actually, while writing this I realized it doesn't only apply to projects, there are also several university-affiliated government-funded centers that are not producing much usable at this point in time)

I am sure any fundamental scientists that reads this post will probably come out with a great reason for their projects to be funded, and while scientifically I will agree with the importance of them, I will in many cases (but of course not all) disagree with their timing. At the very least, we should be able to explain why this is the right moment for the taxpayers to pay for a particular project.

For the last year I have been the TA for a pre-med physics course. My job was basically to prepare the homework questions, hold a few hours of problem sessions a week and have reviews every time they had a test coming up (the nicest part was that I didn't have to grade anything, the professor decided to do the grading himself). I had always taught labs for engineering students and the experience of TAing for a lecture has been very different than that for labs. For one, in the labs we are always given a manual (written by professors in the department) with the experiments, procedures and goals all stated in it. As a TA I never had any chance of doing things the way I wanted or thought would be better.

This time, it was very different. I was given 1)the syllabus, with all the dates and topics/chapters the professor would cover in the lecture and 2) a copy of the textbook they would be using. The rest was up to me: what to do during problem sessions and how to review for the exams. It ended up with me first giving a mini-lecture of the most important concepts in the chapter and proposing a few problems to solve. The rest was for students to ask questions about their homework problems.

At the end of the semester I asked the students to give me their feedback on my performance (I do not get official evaluations as a lecture TA, but I would as a lab TA). I was surprise because this time almost all of the students that filled out the feedback form said that my teaching style and analogies was what actually helped them get through the course. Apparently (I say apparently because I have never seen the professor give a lecture), the professor did a horrible job in the classroom being way too technical in this teaching of physics. I told a few fellow grad students and they wanted to know that this teaching style and analogies was all about. So I decided to give them an example:

One of the last chapters covered in this class was on Quantum Mechanics, mostly on potential wells and hydrogen-like type of problems. When I was trying to describe that in these "constrained" systems the particle can only take discrete values of energies I noticed that while everybody shook their heads in a yes motion, most of them didn't understand what that meant (I found this out by asking them a question and very few got it right). So I made the analogy to a stair, I said: Unless you can fly, the only values of potential energy that you can have while both feet are at the same level are those given by mgh, where h depends on the number of steps you have gone up or down. Then, I realized that I could use this same idea to explain why lower energy levels are always first filled, I said: Now, imagine that the atom (for example) is actually a concert hall, and in the nucleus you have the stage. You are an electron that wants to go see the show, would you like to sit in the front or in the back? Everyone said front. If you imagine a concert hall with the layout of the room we were in, the front seats had the lower energy, and therefore electrons would take always the front seats, to be closer to their idol (Ok, I actually said American Idol and they all laughed). The professor later gave a quiz related to level-filling and I checked to see how "my" students did. Most of them were in the higher-grade group.

When I was done telling my fellow grad students my analogy, they all disagreed with my "style". They asked: is this how you always do it? I replied, well, it's definitely not always the same analogy :), and it definitely depends on the audience, but yes, for not physics and engineering majors this is how I do it most of the time. Some got mad at me, and said that I was hurting physics instead of helping. They reasoning is that while I might've told them how things were, I didn't teach them why things were that way. Plus, my analogy was incomplete. They couldn't tell me how it was incomplete and I conceded that yes, in a quantum well, the energy levels depend on the mass of the particle and in my stair example they didn't, but that was beyond my point. All I was going for was that there are discrete energy levels.

I asked them how they would teach the same idea, and two of them said that the only way to do it was through the mathematics, another said he didn't know how to except by repeating what was in the book.

I don't care what they think, in my opinion doing mathematics doesn't explain either why things are the way they are, it only tells you how they are. I am not even sure physics can explain why things are a certain way. But what worries me the most is that many non-majors students will (and many already do) encounter people that think physics can only be thought one way: the way a Physics PhD learned them. Plus, the final grades in this class (not assigned by me, so you can't claim I was biased) were much higher in average for the people that attended my office hours than for those who didn't.

For those of you who teach physics for non-majors, and think/know you do a good job, do you follow the book, rely heavily on mathematics or use alternative methods to teach? If you use the last option, can you provide me with some examples?